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Parents prefer same-day sick care, continuity in pediatrician services
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Primary care pediatric practices that emphasized access to same-day sick visits and physician continuity were more likely to conform to parent’s expectations of enhanced access services, according to recent findings.
“Enhanced access services are intended to improve the quality and family centeredness of care by providing families with additional options for communicating with primary care professionals, such as through 24-hour telephone services and email, and for getting direct care when needed,” Joseph S. Zickafoose, MD, MS, from the division of general pediatrics at the University of Michigan, and colleagues wrote. “However, implementation of enhanced access services is resource intensive for primary care practices and, as a result, practices typically must prioritize which services they will implement and consider potential trade-offs with services the practice currently provides.”
To assess parental preferences for enhanced access services, the investigators administered an Internet-based survey to a national sample of 820 U.S. parents (41.2% response rate) from Dec. 8, 2011 to Dec. 22, 2011. The parents’ children were aged 0 to 17 years. The survey entailed a discrete choice experiment, which presented hypothetical scenarios for respondents to choose between two or more choices with specific characteristics assigned different values.
Respondents’ choices were used to deduce their relative preferences of each characteristic, and their receptivity to making trade-offs between characteristics. Enhanced access services included:
- communication outside of office visits;
- same-day sick visits;
- professional continuity;
- late office hours;
- weekend hours;
- wait times to next available visit; and
- weekday hours.
The most strongly preferred characteristics were: guaranteed same-day sick visits (coefficient = 0.571; P < .001); and higher physician/professional continuity (coefficient = 0.361; P < .001).
Respondents also expressed a greater likelihood of choosing practices with 24-hour access to telephone advice plus nonemergency email service (coefficient = 0.084; P <.05) evening hours more than 4 days a week (coefficient = 0.142; P <.001) and some weekend hours.
There was a significantly decreased likelihood for respondents to choose practices that were closed during some weekday hours or had wait times for preventive care visits of more than 4 weeks. Differences in respondent preferences between different sociodemographic traits were minimal. The marginal willingness to travel was 14 minutes (95% CI, 11-16 minutes) for guaranteed same-day sick visits and 44 minutes (95% CI, 37-51 minutes) for an office with optimized levels of all desired services.
“Implementation of the medical home model has been criticized for being driven by the preferences of practices and health systems and not being truly patient centered in responding to the needs and expectations of patients and their families,” Zickafoose and colleagues wrote. “The results from this study could be used by practices at any stage of medical home implementation to consider which enhanced access services they should prioritize to best meet the preferences of families.” – by Jen Byrne
Disclosure: The researchers report no relevant financial disclosures.
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